Statins (HMG-CoA
Reductase Inhibitors) are the mainstay treatment
elevated serum LDL cholesterol.
Common side
effects (5% to 10% of patients) : gastrointestinal upset and myalgia.
Patients at
risk for myalgia: old age, renal impairment, obesity, and interaction with
other drugs.
Make sure
that the patient is not on:
fibrates,
itraconazole, ketoconazole, cyclosporin , nefazodone, erythromycin, and clarithromycin.
Warn
patients that consuming large quantities of grapefruit juice may increase the
risk of myositis.
Patients on
simvastatin may have increased levels of Warfarin, amiodarone and digoxin.
Statins are
contraindicated during pregnancy or lactation.
During
follow up:
Check serum Creatine Kinase (CK) at baseline, and after initiation of treatment if the
patient complains of myalgia.
Discontinue
if CK is more than 10 times the upper limit of normal. (less severe elevation
is acceptable, though should be carefully monitored).
Check
liver enzymes before and after initiation of therapy (shouldn't exceed 3 times
the upper limit of normal).
Check serum
lipids (if the indication is dyslipidemia), regularly until normalized, then
once per year.
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